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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11/3/2020 <br />Name Becca Plantz Department Public Works <br />BPW Date 11/24/2020 Phone Extension 5998 <br />Review and Approval Required Prior to Submittal to Board <br />Diversity Compliance <br />and Inclusion Officer ❑ Officer Name Michael Patton <br />BPW Attorney <br />❑ Attorney Name <br />Dept. Attorney ❑ Attorney Name <br />Purchasing ❑ <br />Clara McDaniels <br />Check the Appropriate Item Type — Required. for All Submissions <br />® Professional Services Agreement ❑ Contract ❑ Proposal <br />❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes <br />❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA <br />❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution <br />n Other: n Ease./Encroach <br />Company or Vendor Name <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />Information <br />Jones Petrie Rafinski <br />❑ Yes[] If Yes, Approved by Purchasing <br />® No <br />❑ WBE Completed E-Verify Form Attached ❑❑ Nos <br />2021 Small Drainage <br />121-006 <br />Stormwater Professional Services <br />PR-00005212 <br />$44,185.00 <br />Hourly NTE <br />Design services for several small drainage locations and Randolph Park <br />improvements. <br />Amount of ❑ Increase <br />❑ Decrease <br />Previous Amount $ <br />Current Percent of Change <br />New Amount <br />Total Percent of Change: <br />Time Extension Amount: <br />New Completion Date: <br />Increase <br />Decrease <br />Increase <br />Decrease <br />